| NPI | 1508388539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ POD-000974) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5586) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2023-06-01 |